Parental physical activity, parental mental health, children's physical activity, and children's mental health.

Introduction: The benefits of physical activity for mental health and well-being and the associations between parental mental health and children's mental health have been well established. These important issues tend to be examined separately however, and there is limited research on the associations between parent and child physical activity and mental health when all considered together. While family focused practice is recommended to provide support for parents who have mental health problems and their families and includes various components (such as psychoeducation, support for mental health and parenting), promoting physical activity for parents and children is not usually a core component of these interventions. Methods: The Northern Ireland Youth Wellbeing Survey aimed to provide estimates of the prevalence of mental health problems among children and young people. The survey also included questions about parental physical activity, parental mental health, and children's physical activity (for those aged 11-19 years). The main aim of the analysis reported in this article was to explore possible bivariate associations between parent and child physical activity and mental health and also explore these associations when all considered together. Participants were included in the analysis where there were completed interviews for the young person and one of their parents, and both young person and parent provided responses in relation to questions on weekly physical activity (n = 882). Results: The findings highlight the positive associations between parental physical activity and parental mental health, and between children's physical activity and children's mental health. They also explore some of the more complex interactions between these four variables, which suggest that gender may also be an important consideration. There were significant associations between father's physical activity and son's mental health, and son's physical activity and father's mental health. Discussions: These findings suggest that including support for parental physical activity and children's physical activity should be a routine component of family focused mental health interventions. It is important to acknowledge that there may be additional barriers to engaging in physical activity for families where a parent is experiencing mental health problems, and these should also be explored and addressed.

A Scoping Review of Mental Health and Wellbeing Outcome Measures for Children and Young People: Implications for Children in Out-of-home Care.

Purpose: One of the challenges for mental health research is the lack of an agreed set of outcome measures that are used routinely and consistently between disciplines and across studies in order to build a more robust evidence base for how to better understand young people's mental health and effectively address diverse needs. Methods: This study involved a scoping review of reviews on consensus of the use of mental health and wellbeing measures with children and young people. We were particularly interested to identify if there are differences in measures that are recommended for children and young people with care experience including those with developmental disabilities. Findings: We identified 41 reviews, of which two had a focus on child welfare settings, three on childhood trauma and 14 focused on children and young people with developmental disabilities. Overall, our review highlights a lack of consensus and a diversity of measures within the field. We identified 60 recommended measures, of which only nine were recommended by more than one review. Conclusions: Our review highlights the need for greater agreement in the use of mental health outcome measures. While our review highlights that there is value in identifying measures that can be used with any child or young person, researchers need to take into account additional considerations when working with children and young people with care experience and those with developmental disabilities, to ensure measures are accessible and sensitive to their life experiences.

Factors that influence participation in physical activity for people with bipolar disorder: a synthesis of qualitative evidence.

BACKGROUND: Mental health problems contribute significantly to the overall disease burden worldwide and are major causes of disability, suicide, and ischaemic heart disease. People with bipolar disorder report lower levels of physical activity than the general population, and are at greater risk of chronic health conditions including cardiovascular disease and obesity. These contribute to poor health outcomes. Physical activity has the potential to improve quality of life and physical and mental well-being. OBJECTIVES: To identify the factors that influence participation in physical activity for people diagnosed with bipolar disorder from the perspectives of service users, carers, service providers, and practitioners to help inform the design and implementation of interventions that promote physical activity. SEARCH METHODS: We searched MEDLINE, PsycINFO, and eight other databases to March 2021. We also contacted experts in the field, searched the grey literature, and carried out reference checking and citation searching to identify additional studies. There were no language restrictions. SELECTION CRITERIA: We included qualitative studies and mixed-methods studies with an identifiable qualitative component. We included studies that focused on the experiences and attitudes of service users, carers, service providers, and healthcare professionals towards physical activity for bipolar disorder. DATA COLLECTION AND ANALYSIS: We extracted data using a data extraction form designed for this review. We assessed methodological limitations using a list of predefined questions. We used the "best fit" framework synthesis based on a revised version of the Health Belief Model to analyse and present the evidence. We assessed methodological limitations using the CASP Qualitative Checklist. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) guidance to assess our confidence in each finding. We examined each finding to identify factors to inform the practice of health and care professionals and the design and development of physical activity interventions for people with bipolar disorder. MAIN RESULTS: We included 12 studies involving a total of 592 participants (422 participants who contributed qualitative data to an online survey, 170 participants in qualitative research studies). Most studies explored the views and experiences of physical activity of people with experience of bipolar disorder. A number of studies also reported on personal experiences of physical activity components of lifestyle interventions. One study included views from family carers and clinicians. The majority of studies were from high-income countries, with only one study conducted in a middle-income country. Most participants were described as stable and had been living with a diagnosis of bipolar disorder for a number of years. We downgraded our confidence in several of the findings from high confidence to moderate or low confidence, as some findings were based on only small amounts of data, and the findings were based on studies from only a few countries, questioning the relevance of these findings to other settings. We also had very few perspectives of family members, other carers, or health professionals supporting people with bipolar disorder. The studies did not include any findings from service providers about their perspectives on supporting this aspect of care. There were a number of factors that limited people's ability to undertake physical activity. Shame and stigma about one's physical appearance and mental health diagnosis were discussed. Some people felt their sporting skills/competencies had been lost when they left school. Those who had been able to maintain exercise through the transition into adulthood appeared to be more likely to include physical activity in their regular routine. Physical health limits and comorbid health conditions limited activity. This included bipolar medication, being overweight, smoking, alcohol use, poor diet and sleep, and these barriers were linked to negative coping skills. Practical problems included affordability, accessibility, transport links, and the weather. Workplace or health schemes that offered discounts were viewed positively. The lack of opportunity for exercise within inpatient mental health settings was a problem. Facilitating factors included being psychologically stable and ready to adopt new lifestyle behaviours. There were positive benefits of being active outdoors and connecting with nature. Achieving balance, rhythm, and routine helped to support mood management. Fitting physical activity into a regular routine despite fluctuating mood or motivation appeared to be beneficial if practised at the right intensity and pace. Over- or under-exercising could be counterproductive and accelerate depressive or manic moods. Physical activity also helped to provide a structure to people's daily routines and could lead to other positive lifestyle benefits. Monitoring physical or other activities could be an effective way to identify potential triggers or early warning signs. Technology was helpful for some. People who had researched bipolar disorder and had developed a better understanding of the condition showed greater confidence in managing their care or providing care to others. Social support from friends/family or health professionals was an enabling factor, as was finding the right type of exercise, which for many people was walking. Other benefits included making social connections, weight loss, improved quality of life, and better mood regulation. Few people had been told of the benefits of physical activity. Better education and training of health professionals could support a more holistic approach to physical and mental well-being. Involving mental health professionals in the multidisciplinary delivery of physical activity interventions could be beneficial and improve care. Clear guidelines could help people to initiate and incorporate lifestyle changes. AUTHORS' CONCLUSIONS: There is very little research focusing on factors that influence participation in physical activity in bipolar disorder. The studies we identified suggest that men and women with bipolar disorder face a range of obstacles and challenges to being active. The evidence also suggests that there are effective ways to promote managed physical activity. The research highlighted the important role that health and care settings, and professionals, can play in assessing individuals' physical health needs and how healthy lifestyles may be promoted. Based on these findings, we have provided a summary of key elements to consider for developing physical activity interventions for bipolar disorder.

Prevalence and risk factors of parental mental health problems: A cross-sectional study.

An understanding of the prevalence and risk factors of parental mental health problems is important for early intervention and prevention measures and shaping services for parents and their children. However, large representative surveys of parental mental health problems and associated risk factors are lacking. The aim of this study was to estimate prevalence rates of parental mental health problems using a standardised measure of psychiatric morbidity (General Health Questionnaire; GHQ-12), in a representative sample of parents and caregivers of children and young people (2-19 years) in Northern Ireland. Further, this study explored associated risk factors of parental mental health problems. A random household survey of parents and children was conducted between June 2019 and March 2020. Parental responses on demographic, economic, familial and psychological measures were collected (N = 2815) and 22% of parents and caregivers screened positive for mental health problems. The STROBE checklist for observational research was adhered to. Multivariate logistic regression indicated that being in receipt of benefits, having poor family support, a history of adverse childhood experiences, a history of exposure to politically motivated violence (the Troubles), and a child with conduct problems and poor health were all independent risk factors of increased parental mental health problems. Findings will help to inform future commissioning and development of services and broaden understanding of the correlates of parental mental health problems.

Comparing mental health and mental capacity law data across borders: Challenges and opportunities.

The island of Ireland is partitioned into Northern Ireland and the Republic of Ireland. In both jurisdictions, there have been important developments in mental health and mental capacity law, and associated policies and services. This includes an emphasis on developing more comprehensive approaches to collecting data on outcomes and so there is an opportunity to align these processes to enable comparison and shared learning across the border. This article explores: legal and policy developments; international approaches to mental health outcomes; and the type of data that would be helpful to collect to better understand the use of mental health and mental capacity laws. It is argued that an inclusive strategy to developing a comprehensive, integrated and aligned approach to collecting and analysing data would benefit citizens, policy makers and professionals.

Centre-based early education interventions for improving school readiness: A systematic review.

Background: Globally, children are legally obliged to attend school at a certain age (ranging from 4 to 7 years old). Developmental differences are rarely considered at school entry nor are they always reflected in the teaching and learning environment. Children who start school without being ready to cope may be significantly disadvantaged. Failure at school can impact directly on long-term outcomes such as unemployment, crime, adolescent pregnancy, and psychological and physical morbidity in adulthood. In contrast, experiencing success at school can impact positively on a child's self esteem, behaviour, attitude, and future outcomes. School readiness interventions aim to prepare a child for the academic content of education and the psychosocial competencies considered important for learning such as self-regulation, listening, following instructions and learning to share in play and other social settings. There is a need for evidence of the effectiveness of centre-based school readiness interventions. Objectives: To evaluate the effectiveness of centre-based interventions for improving school readiness in preschool children. Search Methods: In October 2021 we searched CENTRAL, MEDLINE, Embase, ERIC, PsycINFO, ERIC, eight additional databases and three trials registers. Other eligible studies were identified through handsearches of reference lists, reports, reviews and relevant websites. Selection Criteria: We included randomised controlled trials (RCTs) and quasi-RCTs comparing centre-based school readiness interventions to no intervention, wait-list control or treatment as usual (TAU) for children (aged three to 7 years before starting compulsory education). The primary outcomes were school readiness and adverse effects. Data Collection and Analysis: We used standard methodological procedures expected by Cochrane. We used GRADE to assess the certainty of evidence. Main Results: We included data from 32 trials involving 16,899 children (6590 included in at least one meta-analysis). Four studies compared centre-based early education interventions with no treatment controls. Twenty-two trials compared an enriched school curriculum to treatment as usual (TAU). Children were aged between 3 and 7 years old (mean age 4.4 years), 51.7% were boys and at least 70% were from a racial/ethnic minority group. Most studies were conducted in the USA and mainly located in areas of high socioeconomic deprivation. Interventions were delivered in centre-based settings (pre-kindergarten or elementary schools), for at least one half day, 4 days per week over the academic year. Follow-up ranged from up to 1 year (short-term), 1-2 years (medium-term) and over 2 years (long-term). We judged the certainty of evidence to be very low to moderate across all outcome measures. We downgraded the certainty of the evidence because the included studies were at an unclear or high risk of bias due to poor reporting, imprecision arising from small sample sizes and wide confidence intervals, and inconsistency due to statistical heterogeneity. Most studies were considered to be low or unclear risk for selection, detection, performance, attrition, selective reporting, and other bias. Allocation bias was at high risk in 10 studies. The US federal government funded most of the studies. Comparison 1. Centre-based early education interventions for improving school readiness versus no intervention Cognitive development. There may be little to no difference in cognitive development between centre-based early education interventions and no intervention at long-term follow-up (MD: 3.28, 95% CI: 0.23 to 6.34; p = 0.04; 2 studies, 361 participants; low certainty evidence). Emotional well-being and social competence. There may be no clear difference in social skills in centre-based early education interventions compared to the no intervention control group at short-term follow-up (SMD: -0.11, 95% CI: -0.54 to 0.33; p = 0.63; 3 studies, 632 participants; low certainty evidence). Heterogeneity for this outcome was substantial (I² = 71%). Health development. Narrative analysis from a single study showed that centre-based early education interventions may improve health development outcomes such as health checks, immunisation compliance and dental care (1 study, 142 participants; low certainty evidence).None of the studies reported on school readiness, adverse effects, or physical development. Comparison 2. Centre-based early education interventions for improving school readiness versus TAU School readiness. The evidence is very uncertain about the effect of centre-based early education interventions compared to TAU on school readiness up to 1 year post-intervention (SMD: 1.17, 95% CI: -0.61 to 2.95; p = 0.20; 2 studies, 374 participants; very low certainty evidence). Heterogeneity for this outcome was considerable (I² = 95%). Cognitive development. The evidence is very uncertain about the effect on cognitive development between centre-based early education interventions and TAU at long-term follow-up (MD: 9.34, 95% CI: -6.64 to 25.32; p = 0.25; 2 studies, 136 participants; very low certainty evidence). Heterogeneity for this outcome was considerable (I² = 92%). Emotional well-being and social competence. A meta-analysis of 12 studies demonstrated there may be little to no difference in social skills between centre-based early education interventions and TAU at short-term follow-up (SMD: 0.11, 95% CI: -0.05 to 0.28; p = 0.19; 12 studies, 4806 participants; low certainty evidence). Physical development. Evidence from one study showed that centre-based early education interventions likely have little to no difference in increasing fine motor skills compared to TAU at short-term follow-up (MD: 0.80, 95% CI: -1.11 to 2.71; 1 study, 334 participants; moderate certainty evidence).None of the studies measured adverse effects or health development. Authors' Conclusions: We found very low, low and moderate-certainty evidence that centre-based interventions convey little to no difference to children starting school compared to no intervention or TAU, up to 1 year. More research, measuring relevant outcomes, conducted outside the USA, is required to improve programmes designed to meet the needs of children starting school.

The structure of the Prodromal Questionnaire-16 (PQ-16) in a non-help-seeking youth population: Exploratory and confirmatory factor analyses study.

AIMS: The present study aimed to examine the structure of the Prodromal Questionnaire-16 (PQ-16) in a non-help-seeking youth population through exploratory and confirmatory factor analysis. Previous studies have not examined the structure of this self-report measure in this age group outside a clinical setting. METHODS: Participants (n = 1165) aged 11-19 years were recruited to an epidemiological study of young people in Northern Ireland, and completed the PQ-16 alongside other measures. The dataset was split randomly in two for separate factor analyses. A polychoric correlation matrix was created and exploratory factor analysis was used to identify the optimal number of factors. In addition, based on previous studies, six models were tested through confirmatory factor analysis to determine best fit. A one-factor, 3 two-factor, a three-factor and a four-factor model were all tested. RESULTS: The exploratory factor analysis indicated a two-factor structure of the PQ-16 in this population, which we have labelled 'general unusual experiences' and 'hallucinations'. Confirmatory analysis indicated that the two-factor model identified through the exploratory analysis was the best fit for the data. DISCUSSION: The present study suggests that the structure of the PQ-16 may vary across age groups in non-clinical settings, and adds further support to the validity of the PQ-16 is a cost-effective, easy to administer self-report measure that is suitable for use in non-help-seeking populations as a screening tool for prodromal symptoms.

'Lifts your spirits, lifts your mind': A co-produced mixed-methods exploration of the benefits of green and blue spaces for mental wellbeing.

INTRODUCTION: Mental health problems are a considerable public health issue and spending time in nature has been promoted as a way to access a range of psychological benefits leading to the development of nature-based interventions for people with severe and enduring mental health problems. Less, however, is understood about the potential benefits and efficacy of day-to-day routine access to outdoor green and blue spaces for mental health service users. METHODS: Using a mixed-methods design between April and October 2021, we explored the benefits and barriers to spending time outdoors with a purposive sample of mental health service users (N = 11) using qualitative interviews and an online general population survey (N = 1791). Qualitative evidence highlighted the restorative benefits of nature and identified a number of barriers associated with fears around personal safety, social anxiety, fatigue and lack of motivation. COVID-19 had also restricted access to green and blue spaces. Having social contact and support encouraged people to spend time outdoors. In the quantitative survey, self-report and standardised measures (the Patient Health Questionnaire and the Warwick-Edinburgh Wellbeing Scale) were used to assess past and current mental wellbeing. FINDINGS: Statistically significant differences were found between wellbeing and the use of green and blue spaces. Those with mental health problems spent time outdoors because they: felt guilty; wanted to reduce their anxiety; or rely on someone for encouragement. Those without mental health problems endorsed more positively framed reasons including relaxation, improving physical health or getting exercise. Barriers for people with mental health problems involved safety concerns, feeling anxious and having a poor self-image. These findings give insight into motivations for an outdoor activity to help inform the design of public mental health interventions. CONCLUSION: Further work is required to improve access and safety to promote the benefits of green and blue spaces for everyone. PATIENT OR PUBLIC CONTRIBUTION: The research team included expert experienced researchers with a mental health service provider (Praxis Care) and they were involved in the development of the research idea, funding application, design, data collection, analysis, writing up and dissemination activities.

The influence of adverse and positive childhood experiences on young people's mental health and experiences of self-harm and suicidal ideation.

BACKGROUND: Few studies have examined the interaction of adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) with mental health outcomes in nationally representative European populations. OBJECTIVE: The primary objective was to test models of resilience through investigating associations between ACEs and PCEs and young people's risk of common mood and anxiety disorders, self-harm and suicidal ideation. PARTICIPANTS AND SETTING: Data were from the Northern Ireland Youth Wellbeing Survey (NIYWS), a stratified random probability household survey conducted between June 2019 and March 2020. Analysis is based on data from adolescents aged 11-19 years (n = 1299). METHOD: Logistic regression was used to test the direct effects of ACEs and PCEs on mental health outcomes and the moderating effect of PCEs at different levels of ACE exposure. RESULTS: Prevalence rates of mental health outcomes were: common mood and anxiety disorders (16 %); self-harm (10 %); suicidal ideation (12 %). ACEs and PCEs both independently predicted common mood and anxiety disorders, self-harm and suicidal ideation. Every additional ACE increased the likelihood of a common mood and anxiety disorder (81 %), self-harm (88 %) and suicidal ideation (88 %). Every additional PCE reduced common mood and anxiety disorders (14 %), self-harm (13 %) and suicidal ideation (7 %). There was no moderating effect of PCEs on ACEs and mental health outcomes. CONCLUSION: The findings suggest that PCEs act largely independently of ACEs and that initiatives to increase PCEs can assist in the prevention of mental health problems.

Prevalence of probable eating disorders and associated risk factors: An analysis of the Northern Ireland Youth Wellbeing Survey using the SCOFF.

OBJECTIVES: Eating disorders (ED) are associated with significant morbidity and mortality rates and are most common in young people aged between 15 and 19 years. Large representative surveys on disordered eating in youth are lacking. The main aims were to estimate the prevalence of disordered eating in a representative sample of 11-19 year olds in Northern Ireland and investigate the associations between probable eating disorder and a range of risk factors. DESIGNS AND METHODS: A large nationally representative household survey was conducted, and the bivariate and multivariate associations between demographic, familial, economic and psychological risk factors and probable eating disorder were assessed. RESULTS: A total of 16.2% (n = 211) of the sample met the SCOFF screening criteria for disordered eating. Probable eating disorder was associated with being female (OR = 2.44), having a parent with mental health problems (OR = 1.68), suffering from certain psychological problems, such as mood or anxiety disorder (OR = 2.55), social media disorder (OR = 2.95), being the victim of physical bullying (OR = 1.71) and having smoked (OR = 2.46). CONCLUSIONS: This study provides the first prevalence estimates of probable eating disorder among youth in Northern Ireland. Furthermore, the study identifies unique risk factors for probable eating disorder among this representative sample.

An agenda for future research regarding the mental health of young people with care experience.

Young people who are currently or were previously in state care have consistently been found to have much higher rates of mental health and neurodevelopmental difficulties than the general youth population. While a number of high-quality reviews highlight what research has been undertaken in relation to the mental health of young people with care experience and the gaps in our knowledge and understanding, there is, until now, no consensus, so far as we aware, as to where our collective research efforts should be directed with this important group. Through a series of UK wide workshops, we undertook a consultative process to identify an agreed research agenda between those with lived experience of being in care (n = 15), practitioners, policy makers and researchers (n = 59), for future research regarding the mental health of young people with care experience, including those who are neurodiverse/have a neurodevelopmental difficulty. This consensus statement identified 21 foci within four broad categories: how we conceptualize mental health; under-studied populations; under-studied topics; and underused methodologies. We hope that those who commission, fund and undertake research will engage in this discussion about the future agenda for research regarding the mental health of young people with care experience.

'Getting involved in research': a co-created, co-delivered and co-analysed course for those with lived experience of health and social care services.

BACKGROUND: 'Getting Involved in Research' was co-created and delivered by a multi-organisational group to provide an accessible introduction to research for those with lived experience of health and social care services. METHOD: The evaluation of participants' perceptions adopted an exploratory mixed method research design and aimed to gather data to provide an in-depth understanding of the participants' experience of 'Getting Involved in Research' through the co-researchers' analysis of qualitative data using Participatory Theme Elicitation (PTE). PTE was used with the qualitative data to promote co-analysis by the course development group; analyses from an independent academic was also used to further validate the method of PTE. RESULTS: Thirty-five participants in total participated in 'Getting Involved in Research'. Age ranges varied from 19 to 73 years old. Participants were predominately female (n = 24), five males participated (n = 5) and there was one participant who identified as non-binary (n = 1). Six core themes were identified using the PTE approach: (1) A Meaningful Participatory Approach (2) Increasing the Confidence of Participants (3) Interactive Online Format (4) An Ambient Learning Environment (5) A Desire for Future Courses (6) A Balance of Course Content and Discussion. Participants in 'Getting Involved in Research' reported that the content of the training was applicable, relevant, fostered awareness of research methods and anticipated that it would support their involvement in research. CONCLUSION: 'Getting Involved in Research' has contributed innovatively to the evidence base for how to engage with and motivate those who have experience of health and social care to become actively involved in research. This study demonstrates that 'Getting Involved in Research' may be helpful to train those with lived experience and their care partners however, further research following up on the application of the course learning would be required to ascertain effectiveness. FUTURE DIRECTIONS: Future research should explore methods to apply research skills in practice to further develop participants' confidence in using the skills gained through 'Getting Involved in Research'.

The aim of this study was to gather information to help us understand the experience of participants' undertaking a research course called 'Getting Involved in Research'. A group of individuals including those with lived experience of health and social care services, academics, community and voluntary sector workers and a representative from the Department of Health in Northern Ireland worked together to develop a course to encourage and support people to engage with research. The 'Getting Involved in Research', course was designed to provide an understandable introduction to research for those people with lived experience of health and social care. We did this because research in health and social care sector should involve the patients and public who it is intended to help. The evaluation of the course had two distinct phases; we asked course participants to complete a survey before and after the course (pre- and post-course survey) and also asked them to complete a journal reflecting on their experiences after each lecture. This paper gives an overview of the profile of course participants and their responses to the survey questions. The survey answers were analysed using an approach to analysing information which encourages involvement from people with a range of experience of research methods, (known as Participatory Theme Elicitation). Thirty-five participants in total participated in 'Getting Involved in Research'. Age ranges varied from 19 to 73 years old. Participants were predominately female (n = 24), five males participated (n = 5) and there was one participant who identified as non-binary (n = 1). Participants in 'Getting Involved in Research' reported that the content of the course was relevant, encouraged awareness of research methods and encourage their future involvement in research.

Prevalence and risk factors of mood and anxiety disorders in children and young people: Findings from the Northern Ireland Youth Wellbeing Survey.

OBJECTIVE: This paper presents the key findings from the Northern Ireland Youth Wellbeing Prevalence Survey (NIYWS), specifically the prevalence of common mental health disorders and their association with personal, familial and socio-economic risk factors. METHODS: The Northern Ireland Youth Wellbeing Survey (NIYWS) is a large nationally representative household survey of young people aged 2-19 years (N = 3074) and their parents (N = 2816). Data collection was by means of a stratified random probability household survey. Children and young people were eligible to take part if they were aged 2 to 19 and lived in Northern Ireland. Mood and anxiety disorders were measured using the Revised Children's Anxiety and Depression Scale (RCADS: Chorpita et al., 2000). RESULTS: Based on the cut-off scores for the RCADS 11.5% of the sample met the criteria for any mental health disorder. The most prevalent disorder was panic disorder (6.76%) and the least common was generalised anxiety disorder (2.69%). Poor child health, special educational needs, parental separation, living in a household in receipt of benefits, living in an area of deprivation and living in an urban area were all significant predictors of any mood or anxiety disorder. CONCLUSIONS: The results indicate somewhat elevated prevalence rates of mood and anxiety disorders in children and young people in Northern Ireland compared to England and other international countries. These findings can be used to help inform mental health policy and practice.

Systematic review of physical activity interventions assessing physical and mental health outcomes on patients with severe mental illness (SMI) within secure forensic settings.

WHAT IS KNOWN ON THE SUBJECT?: Individuals with a severe mental illness (SMI) are less physically active and have a lower life expectancy than the general population due to increased risks of cardiometabolic diseases (obesity, diabetes and respiratory diseases) and other health risks. Physical activity has been used as an adjunct therapy for individuals with SMI yielding improvements in cognitive functioning, quality of life and a reduction in psychiatric symptoms. Individuals with SMI residing within a secure forensic setting have reduced physical activity opportunities, possibly due to a number of factors including low motivation and restricted access to exercise facilities combined with a lack of knowledge and/or confidence in staff members to assist in physical activity programmes. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This review demonstrates that little is known around the effects of physical activity for people with SMI who reside in secure forensic settings, with little to no long-term effects reported. Physical activity interventions have shown some positive results through decreasing weight and waist circumference as well as a reduction in negative symptom scores in an exercise group compared with the "no treatment" control group post-intervention. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Service users' reluctance to engage in physical activity may be overcome by improving staff commitment, creating a motivational atmosphere and promoting service user decision making. ABSTRACT: INTRODUCTION: Participating in physical activity has many benefits, yet those with severe mental illness (SMI) living in forensic settings are less likely to be active, and more likely to experience ill-health. The aim of this study was to systematically review the effectiveness of physical activity programmes on mental and physical health and specifically on reducing symptoms of SMI in forensic settings. METHOD: A systematic search of six databases was conducted, in addition to a grey literature search. Studies were included if they had participants with SMI; were based in a forensic setting; involved a physical activity programme and reported physical and mental health outcomes. RESULTS: A total of 112 participants were included in four studies. One study showed a significant improvement in negative symptom scores in the exercise group compared with a treatment as usual group. Two studies reported improvements in psychiatric symptoms with no significant difference between groups; however, statistically significant changes in weight and waist circumference were evident (p < .001). No adverse effects were reported. CONCLUSION: Only a small number of studies were included and of limited design and quality, with no follow-up assessments; therefore, more research is needed to determine the true effects of physical activity for improving SMI symptoms in a forensic setting. This review highlights the need for further studies exploring the barriers and facilitators of physical activity in secure forensic settings. Studies are required that include a more thorough research design. Furthermore, interventions if designed with patients and caring staff in mind may lead to lowered psychiatric symptoms and increased physical health benefits for all in forensic settings.

Experiences of childhood adversity across generations - Continuity or change? A study from the Northern Ireland youth wellbeing survey.

BACKGROUND: Although a wealth of international literature consistently links cumulative experiences of adverse childhood experiences (ACEs) with physical, mental and emotional problems in later life, only a few studies have focused on intergenerational ACE exposure and research using nationally representative populations is lacking. OBJECTIVE: This paper examines intergenerational associations between parent and child ACE scores in a large nationally representative sample of parent-child dyads. PARTICIPANTS AND SETTING: Participant comprise 1042 pairs of parents and young people (11-19 year olds) who both completed questions relating to their exposure to ACEs (N = 1042) as part the Northern Ireland Youth Wellbeing Survey (NIYWS) - a stratified random probability household survey of the prevalence of mental health disorders among 2 to 19 year olds in Northern Ireland (N = 3074). METHODS: Hierarchical regression was used to identify the relationship between parent and young people ACE scores and investigate the extent to which this is influenced by child, parent, family and socio-economic variables. RESULTS: In the final model, young person ACE scores were associated with older child age (ß = 0.082, p = .016), younger parental age (ß = -0.083, p = .022), fewer children in the household (ß = -0.120, p < .001), poor child health (ß = 0.160, p < .001), low family support (ß = 0.118, p = .001) and the household being in receipt of benefits (ß = 0.223, p < .001). CONCLUSIONS: This study found a small association between parent and young person ACE exposure which was attenuated through other variables.

Rationale and methods of the 'Northern Ireland Youth Wellbeing Survey' and initial findings from the Strengths and Difficulties Questionnaire.

Backgrounds and Aims: The Northern Ireland Youth Wellbeing Survey (NIYWS) was commissioned by the Health and Social Care Board (NI) with the aim of providing reliable prevalence estimates of the mental health problems of children and young people aged 2-19 years. Method: The NIYWS used a random probability design, stratified by deprivation decile and county, to ensure even geographical distribution and representation. The survey used a broad range of validated measures to identify children and young people who met established clinical criteria for common mood, anxiety and behaviour disorders, trauma related disorders, as well as those at risk of autism spectrum disorder, eating disorders, future psychotic illness, self-injury or suicide. Results: Data were collected on 3074 children and young people aged 2-19 years, as well as over 2800 parents. The survey achieved a high response rate (67%) and initial findings indicated that 11% of the sample were at risk of emotional or behavioural problems. Conclusions: The NIYWS was the first large scale nationally representative survey of the mental health of children and young people in NI. Despite the legacy of political violence the initial findings show comparable levels of emotional and behavioural problems to England.

A scoping review of international policy responses to mental health recovery during the COVID-19 pandemic.

The COVID-19 pandemic has affected people's physical and mental health. Quarantine and other lockdown measures have altered people's daily lives; levels of anxiety, depression, substance use, self-harm and suicide ideation have increased. This commentary assesses how international governments, agencies and organisations are responding to the challenge of the mental health impact of COVID-19 with the aim of informing the ongoing policy and service responses needed in the immediate and longer term. It identifies some of the key themes emerging from the literature, recognises at-risk populations and highlights opportunities for innovation within mental health services, focusing on the published academic literature, international health ministry websites and other relevant international organisations beyond the United Kingdom and Ireland. COVID-19 has challenged, and may have permanently changed, mental health services. It has highlighted and exacerbated pre-existing pressures and inequities. Many decision-makers consider this an opportunity to transform mental health care, and tackling the social determinants of mental health and engaging in prevention will be a necessary part of such transformation. Better data collection, modelling and sharing will enhance policy and service development. The crisis provides opportunities to build on positive innovations: the adaptability and flexibility of community-based care; drawing on lived experience in the design, development and monitoring of services; interagency collaboration; accelerating digital healthcare; and connecting physical and mental health.

An exercise intervention for people with serious mental illness: Findings from a qualitative data analysis using participatory theme elicitation.

BACKGROUND: People with severe mental illness (SMI) often have poorer physical health than the general population. A coproduced physical activity intervention to improve physical activity for people with SMI in Northern Ireland was evaluated by co-researchers (researchers with lived experience of SMI) and academic researchers using a new approach to participatory data analysis called participatory theme elicitation (PTE). OBJECTIVE: Co-researchers and academic researchers analysed the data from the pilot study using PTE. This paper aimed to compare these analyses to validate the findings of the study and explore the validity of the PTE method in the context of the evaluation of a physical activity intervention for individuals with SMI. RESULTS: There was alignment and congruence of some themes across groups. Important differences in the analyses across groups included the use of language, with the co-researchers employing less academic and clinical language, and structure of themes generated, with the academic researchers including subthemes under some umbrella themes. CONCLUSIONS: The comparison of analyses supports the validity of the PTE approach, which is a meaningful way of involving people with lived experience in research. PTE addresses the power imbalances that are often present in the analysis process and was found to be acceptable by co-researchers and academic researchers alike.

The Belfast Youth Development Study (BYDS): A prospective cohort study of the initiation, persistence and desistance of substance use from adolescence to adulthood in Northern Ireland.

BACKGROUND: Substance misuse persists as a major public health issue worldwide with significant costs for society. The development of interventions requires methodologically sound studies to explore substance misuse causes and consequences. This Cohort description paper outlines the design of the Belfast Youth Development (BYDS), one of the largest cohort studies of its kind in the UK. The study was established to address the need for a long-term prospective cohort study to investigate the initiation, persistence and desistance of substance use, alongside life course processes in adolescence and adulthood. The paper provides an overview of BYDS as a longitudinal data source for investigating substance misuse and outlines the study measures, sample retention and characteristics. We also outline how the BYDS data have been used to date and highlight areas ripe for future work by interested researchers. METHODS: The study began in 2000/1 when participants (n = 3,834) were pupils in their first year of post-primary education (age 10/11 years, school year 8) from over 40 schools in Northern Ireland. Children were followed during the school years: Year 9 (in 2002; aged 12; n = 4,343), Year 10 (in 2003; aged 13; n = 4,522), Year 11 (in 2004; aged 14; n = 3,965) and Year 12 (in 2005; aged 15; n = 3,830) and on two more occasions: 2006/07 (aged 16/17; n = 2,335) and 2010/11 (aged 20/21; n = 2,087). Data were collected on substance use, family, schools, neighbourhoods, offending behaviour and mental health. The most novel aspect of the study was the collection of detailed social network data via friendship nominations allowing the investigation of the spread of substance use via friendship networks. In 2004 (school year 11; respondents aged 14), a sub-sample of participants' parents (n = 1,097) and siblings (n = 211) also completed measures on substance use and family dynamics. RESULTS: The most recent wave (in 2010/2011; respondents aged 20/21 years) indicated lifetime use of alcohol, tobacco and cannabis among the cohort was 94, 70 and 45 per cent, respectively. The paper charts the development of drug use behaviour and some of the key results to date are presented. We have also identified a number of key areas ripe for analysis by interested researchers including sexual health and education. CONCLUSIONS: We have established a cohort with detailed data from adolescence to young adulthood, supplemented with parent and sibling reports and peer network data. The dataset, allowing for investigation of trajectories of adolescent substance use, associated factors and subsequent long-term outcomes, constitutes an important resource for longitudinal substance misuse research. A planned further wave as the cohort enter their late twenties and potential to link to administrative data sources, will further enrich the datasets.

The association between child maltreatment and adult poverty - A systematic review of longitudinal research.

Child maltreatment is a global problem affecting millions of children and is associated with an array of cumulative negative outcomes later in life, including unemployment and financial difficulties. Although establishing child maltreatment as a causal mechanism for adult economic outcomes is fraught with difficulty, understanding the relationship between the two is essential to reducing such inequality. This paper presents findings from a systematic review of longitudinal research examining experiences of child maltreatment and economic outcomes in adulthood. A systematic search of seven databases found twelve eligible retrospective and prospective cohort studies. From the available evidence, there was a relatively clear relationship between 'child maltreatment' and poorer economic outcomes such as reduced income, unemployment, lower level of job skill and fewer assets, over and above the influence of family of origin socio-economic status. Despite an extremely limited evidence base, neglect had a consistent relationship with a number of long-term economic outcomes, while physical abuse has a more consistent relationship with income and employment. Studies examining sexual abuse found less of an association with income and employment, although they did find a relationship other outcomes such as sickness absence, assets, welfare receipt and financial insecurity. Nonetheless, all twelve studies showed some association between at least one maltreatment type and at least one economic measure. The task for future research is to clarify the relationship between specific maltreatment types and specific economic outcomes, taking account of how this may be influenced by gender and life course stage.